E1729. Multisystem Imaging of the COVID-19 Patient: Varying Presentations and Complications of COVID-19
  1. Edwarda Golden; Johns Hopkins Hospital
  2. Dmitry Trifanov; Johns Hopkins Hospital
  3. Nagina Malguria; Johns Hopkins Hospital
Coronavirus disease 2019 (COVID-19) is the clinical disease caused by the coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2). The radiologist plays a role in helping to establish the diagnosis of COVID-19 as well as in aiding to detect the many, multisystem complications of COVID-19.

Educational Goals / Teaching Points
After reviewing the educational exhibit, the viewer will be able to describe the epidemiology of COVID-19 and the imaging findings of known complications of COVID-19 including thromboembolic, cardiac, abdominal, neurologic, and musculoskeletal complications. The viewer will also be able to describe the hypercoagulable state created by COVID-19 and its implications for not only venous thromboembolic disease but also microvascular ischemia. Finally, the viewer will be able to understand the imaging appearance of multisystemic inflammatory syndrome in children (MIS-C).

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The pulmonary appearance and complications of COVID-19 vary in severity, mechanism, and timing of findings. The thoracic findings in COVID-19 generally follow an order of ground glass peripheral opacities, followed by consolidations and crazy paving, and finally signs of organizing pneumonia. The principle known mechanism by which SARS-Cov-2 causes severe disease is by precipitating an inflammatory and hypercoagulable state. This pro-thrombotic state leads to venous thromboembolism, even in patients on prophylactic anticoagulation. Furthermore, cadaveric studies have shown microthrombi in the arterioles of major organ systems which is thought to lead to microvascular ischemia and affects the lungs, heart, kidneys, bowel and other solid organs. Neurologic complications of COVID-19 include ischemic cerebral infarctions, acute hemorrhagic necrotizing encephalopathy, as well as the presence of microhemorrhages on MRI, which is associated with critically ill, ventilated patients. Cardiac complications of COVID-19 include viral myocarditis and MIS-C related myocardial dysfunction. Musculoskeletal complications include peripheral limb ischemia. MIS-C is a Kawasaki-like post-COVID complication in children. The manifestations of MIS-C vary widely and include myocardial dysfunction, gastrointestinal manifestations, and respiratory manifestations. Imaging for MIS-C includes MRI for myocardial dysfunction, ultrasound for abdominal symptoms, and neuroimaging for the neurologic symptoms that affect greater than 14% of children with MIS-C and can include new onset encephalopathy and meningoencephalitis.

The complications of COVID-19 are numerous and varied. The imaging of such patients can also be unexpected. It is important to know both the complications of COVID-19 and the caveats of imaging to better serve patient care.